A day with the Pre-Birth Intervention Service
Gabriella Jozwiak
Monday, May 26, 2014
Durham's multiple award-winning Pre-Birth Intervention Service aims to ensure the best possible start in life for babies born to high-risk families. Gabriella Jozwiak went to meet the team to find out how it works.
It is easy to get lost in Durham County Hall's maze of beige corridors. All office doors look the same, except for one. On it is Sellotaped a simple black and white image: a hand cradling a baby's feet. It is a modest way to distinguish a service that looks set to revolutionise the council's children's services.
The Pre-Birth Intervention Service won three of last year's CYP Now awards - for early years, family support and child protection - because of its success in preventing babies going into care or, if necessary, ensuring a swift and smooth transition to a new home.
The awards sit proudly on shelves in the centre of the small office where desks are piled high with case files. A large whiteboard displays five social workers' names: Vicky, Stacey, Denise, Julie, Louise and clinical psychologist Dr Chris. The initials of the families they support are beneath with their babies' due dates.
Team leader Helen Monks explains how senior council managers set up the scheme in response to 2010 research that showed more than half of 45 pre-birth core assessments over one week at the authority involved families who had previously had children removed from their care.
"Since the previous child was removed, no work had been done with that family," she says. "The service developed to support families, to help them to learn from past mistakes and determine if a child can safely go home or needs to be placed elsewhere."
Another driver was the fact that many children were two years old by the time they reached the adoption panel.
The service aims to have a plan in place for a child before it is born, with plenty of research highlighting the importance of stability for young children's development and wellbeing.
Monks reaches for a stack of unbound A4 pages - the pre-birth intervention tool - to show the kind of issues social workers address with each family. These include building relationships between parents, baby development, relaxation and drawing up genograms. "During the first visit, we make it very clear that just by working with us doesn't mean their baby is going home," says Monks. "There's a Plan A, which is that the child comes home and what everyone's aiming for. Plan B is if we don't feel that's a safe option, we look for alternative care."
Social workers also review families' case histories by collecting documents from previous proceedings. They look at the financial situation of significant adults, legal issues, community relationships, physical and mental health, and housing.
Assessment skills are key for team members. "Everything is based on being able to assess the parent before the baby is born to see where change lies," says Monks. They must also be emotionally robust. The previous night to our visit, Monks performed one of the job's most difficult tasks - removing a newborn from a mother. "Mum was really upset and dead emotional," she admits.
The case belongs to social worker Stacey Williams, who was on annual leave the previous day. Today, Williams is setting up contact between the baby and parents, and beginning adoption proceedings. The team never expected the baby could go home, as the mother had two previous children removed and later married a man with a history of sexual abuse.
"The aim was to do some work with our clinical psychologist to determine whether she had any mental health issues we could target, but she hasn't engaged with anything," says Williams, regretfully. Nevertheless, she is satisfied that the team has done the right thing. "I'd be having sleepless nights if I thought the baby was going home today," she says. Williams will next focus on writing a life-story document with the parents - a record that can be referred to when the child is older.
Building strong relationships with families is key to the team's strategy. This is apparent when two mothers arrive at County Hall to tell their stories. Social worker Julie Kelsey greets mother Toni Kay* with a cup of coffee: "Three-sugars - the way she likes it." Kay is 32 and gave birth to a son two weeks ago, just after being released from prison. It was her second sentence and Tyrone* is her fourth child. Her previous three were removed.
Tyrone was placed with foster carers, but Kay still has time to prove she can parent him. She sees him three times a week at a social services contact centre, and is receiving support from the clinical psychologist, substance misuse and housing services. In seven weeks' time, a public law outline child protection conference will decide if she can keep her son.
Kay's skin is aged by alcohol and drug misuse, but her positivity about the intervention suggests a fresh start. At first she was hostile, but over time, Kelsey won her over. "I feel I can get Tyrone back - I know what I have to do," says Kay. "This intervention has definitely changed my life." Her relationship with Kelsey is unlike any she has formerly had with a social worker: "She was straight with me - this time I trusted them."
Kelsey takes a break in her day of statutory visits to describe the weekly sessions with Kay in prison. "After she realised the chance on offer to keep her baby, she was fantastic to work with," says Kelsey. Part of the process involves leaving parents homework tasks, such as writing about their family. "Toni wrote reams," says Kelsey.
If Kay is allowed to keep her baby, rehabilitation will be gradual: "We'll start having baby home for a few hours, then one or two nights a week. It could take months, says Kelsey. She admits it will be "extremely difficult" for Kay if Tyrone is put up for adoption. "But ultimately, I want this baby to be safe," she says. "It's about him, not her."
One of the issues the service tries to address is women who have children removed, but repeatedly fall pregnant in the hope they can eventually keep one, as in the case of Ally Adamson*, 21, who has had three children removed. While the team's work with her during her third pregnancy did not result in her keeping her son, she is adamant it has broken a cycle of childbearing. "As time's gone on, I'm happy the kids have gone because I can focus on making a better future," she says. "At the time, I thought they should have stayed at home - but now I wonder if I could have kept them safe."
Adamson is neatly made-up and softly spoken. It is hard to believe she used to drink a litre of vodka a day and spent four years in a physically abusive relationship. Today, she has a new partner, has given up smoking and drinking, and recently moved to a new flat. "I'm concentrating on getting a job, so when my partner and I do come to have a family, we'll always have money to put food on the table and pay the bills," she says.
Her social worker, Victoria McDowell, is today poring over documents at her desk writing up a Child Permanency Record. She was working until 3am the night before, partly because the team does not have support from social work assistants. "They would do things like arrange contact or a criminal records check, but we have to do everything ourselves," she says.
Despite her lack of sleep, McDowell is in high spirits after receiving a phone call about a parent she formerly supported. The mother was able to keep her child, having previously had three children removed from her care. She is now pregnant again, but her successful parenting means her local authority is happy not to commence proceedings relating to the unborn child.
Future strategy
Funding for the pre-birth service ends in January 2015. But one floor up, manager for statutory services in child protection and disabled children Judith Rayne is planning for the future. "We want to mainstream the pre-birth model into mainstream statutory services, because it can help make decisions quicker and provide evidence for different ways of working with families," she says.
Rayne is considering a two-year plan for a transfer. The final strategy will be approved by head of children's services, Carole Payne, who explains why the whole of children's services "absolutely must continue to work in this way".
Aside from benefits to children and families, she stresses that the scheme is a money saver. Over two years, it has saved the council £544,000 by reducing costs linked to slower outcomes. The scheme has resulted in only three contested care proceedings.
Payne says the service fits into aims of improving adoption processes. The number of adoptions in County Durham has doubled in the past year, due in part to the pre-birth service. Long term, Rayne expects the service will also help reduce the number of looked-after children. "It's almost the holy grail," she enthuses.
As the day draws to a close, the pre-birth team's office is half empty. But consultant clinical psychologist Chris Bonnet has just arrived following external meetings. He works two days a week, seconded from Tees, Esk and Wear Valley NHS Foundation Trust, providing a "psychological perspective" on pre-birth assessments and preparing parents and extended family members for parenting.
"It's about checking someone's ability to think from the child's perspective," says Bonnet. "Before a parent can do that, they need to make sense of their own feelings and experiences."
Post-birth, Bonnet reviews five-minute film clips of the parent with their child during contact time to see how they react to their needs. He says the work is unlike any he has done before in his career with adopted children: "I'm seeing the same children about six years earlier when there's much more chance of making a difference."
Northumbria University has evaluated the project's first-year outcomes, with a report due out later this year. A key strength of the model is its transparency, which could be transferred to other areas of children's services practice, says Sue Lampitt, principal lecturer in social work. "Highly transparent working takes effort and requires a commitment of resources that's hard for local authorities given the financial constraints they face," she says. "But this seems a really good place to put those resources."
*Names have been changed
HOW THE TEAM WORKS
The Pre-Birth Intervention Service launched in March 2012 and is funded until 2015
- It includes a team leader, five social workers, a part-time clinical psychologist and part-time administrator.
- Midwives alert the team of pregnancies (up to 21 weeks) where either parent has previously had a child permanently removed as a result of care proceedings.
- After gaining family consent, a dedicated social worker and family worker from Durham's One Point family support service are appointed.
- About 20 family workers based in Durham's 10 children's centres are trained to deliver the intervention, which runs for 20 weeks pre-birth and 20 weeks post-birth.
- The social worker collects all historical information about the family, including court records.
- The team visits the family twice a week to complete a pre-birth assessment and deliver the intervention. This involves educating parents or extended family about parenting and addresses how parents can change.
- The team sets goals for parents and asks them to complete homework tasks, such as a diary of their baby's movements.
- Every visit is recorded in a communication file left with the family to ensure transparency.
- The clinical psychologist supports the team, which can also refer the family to other care services.
- Evidence collected during the intervention enables the team to demonstrate it is safe for the child to go home after birth or reduce the length of care proceedings.
- Post-birth, the team assesses the child's development and if parents are practicing what they learned pre-birth.
- The team continues to support the parent if the child is put up for adoption.
KEY STATISTICS
- The service has supported 50 families since March 2012
- 36 babies have been born, of which 16 went home, seven were placed with a family member, nine were adopted and four are still being assessed
- 94% of babies have had up to one placement move
- The average age of babies in final placement is 21.1 weeks
- Only 3 hearings have been contested
- The service was funded through the government's Social Work Improvement Fund and a Child and Adolescent Mental Health Services grant totalling £193,000 for two years
- Durham County Council estimates the service has saved £544,000 over two years.